DEPARTMENT  OF  THE  NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309 WASHINGTON NAVY YARD, DC 20374

From: To:

IN   REPLY   REFER  TO:
1850
CORB:003
20 Feb 20

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01555

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 17 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12February 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no.change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-01555
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060831

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O1, Officer in Training, medically separated for “right knee pain” with a disability rating of 10%.

CI CONTENTION: Review all conditions.  The complete submission is at Exhibit A.

SCOPE OF REVIEW: The panel’s scope of review is defined in DoDI 6040.44. It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable. Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation. The panel has neither the role nor the authority to compensate for post- separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws. The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20060623	VARD - 20070413	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Knee Pain	5299-5003	10%	Degenerative Joint Disease, Right Knee	
5010-5260	
10%	
20070221	
Old Medial Meniscus Tear	Cat II					
Pain in Joint Involving Right Knee						
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Right Knee Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent an initial arthroscopic repair of his medial meniscus in January 2005, but required additional surgery (arthroscopic decompression of Baker’s cyst and further meniscal debridement) in June 2005. Post-operative STR clinical entries documented an uncomplicated course with no further surgical indications, but the CI was unable to resume full running and duty requirements. There was ample STR documentation of measured range of motion (ROM), with improving flexion from 120 to 135 degrees (normal 140) and extension to 0 degrees (normal).  There was no STR evidence of persistent effusion, instability or impingement

(locking). The STR did not document more significant ROM limitation (after surgical recovery) or evidence contrary to the above ratable findings.

The 16 May 2006 MEB NARSUM examination, 3 months prior to separation, documented persistent knee pain without reported instability and locking that caused “difficulties standing, walking or running for any extended period of time.” The physical examination recorded a normal gait without effusion, instability or impingement, but there was tenderness. Measured ROM was flexion to 125 degrees and extension to 0 degrees, without specifying painful motion.

At the 21 February 2007 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI complained of constant pain rated 6/10 (no note of instability or locking) that prohibited squatting and “extended weight bearing or sitting.” The physical examination recorded a normal gait, tenderness and no instability or impingement. Measured ROM was flexion to 130 degrees and extension to 0 degrees, specifying painful motion at end-range but no ROM degradation with repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right knee condition 10%, coded 5099-5003 (analogous to degenerative arthritis), without citing evidence or criteria. The panel agreed that the Category II diagnoses (conditions that contribute to the unfitting condition), as per the above rating chart, were intrinsic to the rated condition such that  no separate  rating could be supported without  pyramiding   (VASRD
§4.14), and were therefore appropriately subsumed in the same rating. The VA also rated the knee condition 10%, coded 5010-5260 (traumatic arthritis rated for limitation of flexion), based on the C&P examination and citing tenderness with pain after repetitive use. There was no limitation of motion which supported a minimum 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261). There was no evidence of instability (5257), frequent locking with recurrent effusions (5258) or fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262). There were no other criteria in evidence to support a rating higher than 10% under any applicable VASRD §4.71a code. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right knee condition.

BOARD FINDINGS: In the matter of the right knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends there be no modification or re-characterization of the CI’s disability and separation determination.

2	PD-2017-01555